Section
2.
Sample
Collection
Information
Section
3.
Sample
Process
Dates,
Times,
and
Temperatures
Date
Time
Temperature
(
oC)

Section
4.
Number
of
Positive
Tubes
10.0
mL
1.0
mL
0.1
mL
0.01
mL
0.001
mL
10.0
mL
1.0
mL
0.1
mL
0.01
mL
0.001
mL
24­
h
LTB
read
from
24­
h
LTB
read
48­
h
LTB
read
from
48­
h
LTB
read
Total
positive
Section
5.
Calculations
Section
6.
Comments
1Ground
water
under
the
direct
influence
of
surface
water
Combination
of
positives:

Most
probable
number:

E.
coli
per
100
mL:
EC­
MUG
incubation
24­
hour
read
(
from
48­
hour
LTB)
Long­
Term
2
Enhanced
Surface
Water
Treatment
Rule
Source
Water
Monitoring
Method
Type:
15­
tube
MPN
Analytical
Method
Number:
SM
9221B/
9222F
(
LTB/
EC­
MUG)

LTB
incubation
start
LTB
24­
hour
incubation
read
LTB
48­
hour
incubation
read
EC­
MUG
incubation
24­
hour
read
(
from
24­
hour
LTB)

LTB
EC­
MUG
Section
1.
Laboratory
Identification
Information
Laboratory
name:
Laboratory
ID:

Sample
ID
(
optional):
Sample
collection
date:

Sample
collection
point
ID:
Turbidity
result
(
NTU):

Source
water
type
(
circle
one):
Flowing
stream
(
FS)
Reservoir/
lake
(
RL)
1GWUDI­
FS
1GWUDI­
RL
PWS
ID:
Sample
collection
time:

PWS
facility
ID:
Holding
time:

Draft
June
2003
